tp12-1201 final amend i 04.23.12.doc

AMENDMENT I (04/17/12):

The purpose of this amendment, dated April 17, 2012, is to correct the following information:

1. Add Appendix 15:

(Beginning on Page 243)

“PHEP Budget Period 1 Requirements for Territories and Freely Associated States”

2. Correction in “Guidance for Overlapping Budget Periods

– PHEP only” to change 39-day overlap period 40-day overlap period on page 89 only

3. Updated Table of Contents to reflect new page numbers.

Table of Contents

Part 1. Overview Information

Part 2. Full Text of the Announcement

Section I. Funding Opportunity Description

Section II. Award Information

Section III. Eligibility Information

Section IV. Application and Submission Information Section V. Application Review Information

Section VI. Award Administration Information

Section VII. Agency Contacts

Section VIII. Other Information

Appendices

Appendix 1: HPP Budget Period 1 Funding

Appendix 2: PHEP Budget Period 1 Funding

Appendix 3: Cities Readiness Initiative Funding

Appendix 4: At-a-Glance Summary of Healthcare

Preparedness Capabilities:

National Guidance for Healthcare System Preparedness

Appendix 5: At-a-Glance Summary of Public Health

Preparedness Capabilities: National Standards for State and Local Planning

Appendix 6: HPP-PHEP Performance Measures

Appendix 7: HPP Performance Measures

Appendix 8: HPP Benchmarks

Appendix 9: PHEP Performance Measures

Appendix 10: PHEP Benchmarks

Appendix 11: HPP Exercises: Evaluation and Annual Progress Report Requirements Appendix 12: Emergency System for Advance

Registration of Volunteer Health

Professionals (ESAR-VHP) Compliance Requirements

Appendix 13: Withholding and Repayment Guidance Appendix 14: Awardee Resources

Appendix 15:

PHEP Budget Period 1

Requirements for Territories and Freely

Associated States

PART 1. Overview Information

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Federal Agency Names Office of the Assistant Secretary for Preparedness and Response (ASPR) Centers for Disease Control and Prevention (CDC)

Funding Opportunity Title: Hospital Preparedness Program (HPP) and Public Health Emergency Preparedness (PHEP) Cooperative Agreements

Announcement Type New – Type 1 Agency Funding Opportunity Number CDC-RFA-TP12-1201 Catalog of Federal Domestic Assistance Numbers

93.889 – National Bioterrorism Hospital Preparedness Program

93.069 – Public Health Emergency Preparedness

Key Dates To receive notification of any changes to CDC-RFA-TP12-1201 return to the synopsis page of this announcement at www.grants.gov and click the “Send Me Change Notification E-mails” link. An e-mail address is needed for this service.

Application Deadline: May 01, 2012, 11:59 p.m. U.S. Eastern Time Executive Summary Threats to human health and national health security are always present. Whether caused by natural, unintentional, or intentional means, these threats can rapidly overwhelm public health and healthcare systems. Preparing governmental jurisdictions, communities, health and emergency response systems, and other Emergency Support Function (ESF) #8 partners to prevent, protect against, respond to, mitigate, and rapidly recover from these threats is critical for protecting and securing our nation’s healthcare system and public health infrastructure.

HPP-PHEP Grant Alignment

Public health and healthcare preparedness is achieved when component partners at the federal, state, local, tribal, territorial, and nongovernmental levels work in synergy to prepare for, respond to, and rapidly recover from health security incidents and emergencies.

To advance all-hazards preparedness and national health security, promote responsible stewardship of federal funds, and reduce awardee administrative burden, the U.S. Department of Health and Human Services’ (HHS) Office of the Assistant Secretary for Preparedness and Response (ASPR) and Centers for Disease Control and Prevention (CDC) are aligning the administrative and programmatic aspects of the ASPR Hospital Preparedness Program (HPP) and the CDC Public Health Emergency Preparedness (PHEP) cooperative agreements. This funding opportunity announcement describes the ASPR and CDC terms and conditions of the award, the overall purpose of the HPP and PHEP programs, and strategies for achieving program outcomes.

As ASPR and CDC align the two preparedness programs, which represent critical sources of funding and support to our nation’s public health and healthcare preparedness systems, ASPR and CDC are committed to the following goals:

· Increase program impact and advance preparedness

· Reduce awardee burden and enhance customer service provided to states and localities

· Improve federal efficiencies

· Promote innovation

· Demonstrate a clear return on investment and communicate preparedness accomplishments to help ensure sustainability of the PHEP and HPP cooperative agreements

This alignment has resulted in several key changes for the 2012 HPP-PHEP grant cycle. Among the changes are a single HPP-PHEP funding opportunity announcement, funding application, and grant award. An aligned grant cycle is also being implemented, as well as aligned reporting requirements. The annual HPP-PHEP grant cycle will begin July 1 and end June 30.

The new HPP-PHEP project period is five years. Funding applications for Budget Period 1 of the new cooperative agreements are due no later than 60 calendar days after publication on www.grants.gov. Budget Period 1 begins July 1, 2012. Available fiscal year 2012 funding for Budget Period 1 is $351,644,731 for the HPP program and $619,447,806 for the PHEP program. Funding is intended to help awardees demonstrate measurable and sustainable progress toward achieving the public health and healthcare preparedness capabilities outlined in this guidance and other activities that promote safer and more resilient communities.

Capabilities-based Approach HPP and PHEP awardees have made significant progress over the past decade in building and sustaining public health and healthcare preparedness capabilities. The aligned HPP and PHEP cooperative agreement programs support the National Health Security Strategy and follow a capabilities-based approach, building upon the strong preparedness foundation already in place at the state and local levels.

The HPP and PHEP cooperative agreements are authorized by sections 319C-1 and 319C-2 of the Public Health Service (PHS) Act as amended by the Pandemic and All-Hazards Preparedness Act (PAHPA) of 2006 . The purpose of PAHPA is to improve the nation’s public health and medical preparedness and response capabilities for emergencies, whether deliberate, accidental, or natural. HPP and PHEP are consistent with PAHPA and Presidential Policy Directive (PPD) 8: National Preparedness, which aims to strengthen the security and resilience of the United States through systematic preparation for the threats that pose the greatest risk to the security of the United States. PPD 8 directs the development of a National Preparedness Goal, which was adopted in September 2011 and establishes the 35 core capabilities required across the whole community to prevent, protect against, mitigate, respond to, and recover from the threats and hazards that pose the greatest risk.

Consistent with this national approach to planning through the development of “whole-of-community” approaches, ASPR and CDC developed the following documents to serve as foundational guidance for the aligned programs: Healthcare Preparedness Capabilities: National Guidance for Healthcare System Preparedness (http://www.phe.gov/Preparedness/planning/hpp/reports/Documents/capabilities.pdf) and Public Health Preparedness Capabilities: National Standards for State and Local Planning (http://www.cdc.gov/phpr/capabilities/DSLR_capabilities_July.pdf).

This announcement is only for non-research activities supported by ASPR and CDC. If research is proposed, the application will not be reviewed. For the definition of research, please see the CDC Web site at the following Internet address:

http://www.cdc.gov/od/science/integrity/docs/cdc-policy-distinguishing-public-health-research-nonresearch.pdf.

PART 2. FULL TEXT

Section I. Funding Opportunity Description Statutory Authority

Hospital Preparedness Program Funding (HPP): 319C-2 of the Public Health Service (PHS) Act, as amended by the Pandemic and All-Hazards Preparedness Act (PAHPA) (P.L. 109-417) (2006).

Public Health Emergency Preparedness Program Funding (PHEP): 319C-1 of the Public Health Service (PHS) Act, as amended by the Pandemic and All-Hazards Preparedness Act (PAHPA) (P.L. 109-417) (2006).

Contingent Emergency Response Funding (PHEP Only)

317(a) and 317(d) of the PHS Act, subject to available funding and other requirements and limitations.

This guidance describes a separate mechanism for awarding future contingent emergency response funding that may be issued in the event of a pandemic or an all-hazards public health emergency in one or more jurisdictions. Such funding is subject to restrictions imposed by CDC at the time of the emergency and would provide funding under circumstances when a delay in award would result in serious injury or other adverse impact to the public.

Since the funding is contingent upon Congressional appropriations, whether contingent emergency response funding awards can be made will depend upon the facts and circumstances that exist at the time of the emergency; the particular appropriation from which the awards would be made, including whether it contains limitations on its use; authorities for implementation; or other relevant factors. Funding will be subject to the funding authority, e.g., sections 317(a) and (d) of the PHS Act, the relevant notice of award, including restrictions imposed at the time of the emergency, and applicable grants regulations and policies. No activities are specified for this authorization at this time.

Background and Rationale Interagency Grant Coordination

Several federal partners, namely ASPR, CDC, HHS’ Health Resources and Services Administration (HRSA), the Department of Homeland Security’s Federal Emergency Management Agency (FEMA), and the Department of Transportation’s (DOT) National Highway Traffic Safety Administration (NHTSA), distribute preparedness funds and/or provide technical assistance in support of a variety of homeland security, emergency management, public health, and healthcare preparedness activities. Some agencies provide direct emergency public health and healthcare systems preparedness grant funding support to states and local and private entities. Other agencies help to coordinate federal agencies involved with state, local, tribal, and regional emergency medical services and develop projects of national significance which are important components of ensuring consistent national strategies.

Improved coordination among federal emergency preparedness programs is a high-level priority of many entities, including the White House National Security Staff, the Office of Management and Budget, and HPP and PHEP awardees. In December 2010, an Interagency Work Group from ASPR, CDC, HRSA, FEMA, and NHTSA engaged in an interest-based, consensus-building process to co-develop goals, strategies, and action plans to better align grants with public health and healthcare preparedness components.

In July 2011, these agencies signed a memorandum of understanding (MOU), agreeing to cooperatively assess current preparedness grant programs and to engage in collaborative efforts to improve interagency grant coordination. The MOU establishes a formal framework that supports joint federal planning designed to focus investments and to improve and measure preparedness.

HPP-PHEP Grant Alignment

ASPR and CDC have aligned the HPP and the PHEP cooperative agreements through development of key points of intersection. These include:

· One funding opportunity announcement, funding application, and grant award

· Integrated technical assistance, site visits, and annual joint preparedness conferences

· Data management, reporting, and alignment of business processes

· Common Web-based IT portal for awardees

· One grants administration agency

· Aligned HPP and PHEP grant cycles

· Aligned preparedness capabilities

· Co-development of some performance measures

· Consistent budgetary requirements

· Engagement of stakeholders

Benefits of State and Local Coordination

Awardees have made significant progress over the past decade in building and sustaining public health and healthcare preparedness capabilities. The aligned HPP and PHEP cooperative agreement programs will follow a capabilities-based approach, building upon the strong preparedness foundation already in place at the state and local levels. In addition, this joint funding opportunity announcement is intended to foster and accelerate alignment of HPP and PHEP programs in the 62 awardee jurisdictions.

At the state and local levels, many PHEP and HPP programs already are closely aligned, and CDC and ASPR have similarly aligned to better support state and local efforts. The benefits of greater alignment of HPP and PHEP programs in the 62 awardee jurisdictions include:

· More coordinated and integrated public health and healthcare system planning and response

· Improved ability to leverage funding for applicable activities and infrastructure

· Reduced awardee burden regarding duplicative and sometimes conflicting activities and redundant reporting

HPP and PHEP grant alignment is a long-term initiative that will continue to evolve throughout the project period as the two programs seek additional opportunities to improve administrative and programmatic collaboration in the joint administration of the HPP and PHEP cooperative agreements. While working toward closer alignment in many aspects, ASPR and CDC recognize that the capabilities required to fulfill HPP and PHEP programmatic goals differ and that both programs will continue to remain stand-alone programs in accordance with their authorizing legislation.

National Standards for Public Health and Healthcare Preparedness Regardless of the threat, strong and resilient public health and healthcare systems are the cornerstone of an effective response at the local level. Public health departments have made significant progress since 2001, as demonstrated in the ASPR report, From Hospitals to Healthcare Coalitions: Transforming Health Preparedness & Response in Our Communities, http://www.phe.gov/Preparedness/planning/hpp/Documents/hpp-healthcare-coalitions.pdf, and CDC’s state preparedness reports (http://www.cdc.gov/phpr/pubs-links/pubslinks.htm). However, state and local planners have expressed concerns over their ability to sustain the real and measurable advances made in public health and healthcare preparedness since September 11, 2001, when Congress appropriated funding to expand its support nationwide for public health and healthcare preparedness programs.

ASPR and CDC have developed preparedness capabilities with complementary content that describes how each discipline – public health and healthcare systems – contributes expertise to each capability, promoting safer, more resilient communities. The public health and healthcare preparedness capabilities are designed to help state and local health departments with their strategic planning. Released in March 2011, CDC’s Public Health Preparedness Capabilities: National Standards for State and Local Planning establishes national standards for public health preparedness capabilities-based planning that assists state and local planners in identifying gaps in preparedness, determining specific jurisdictional priorities, and developing plans for building and sustaining public health capabilities.

Similarly, ASPR has defined healthcare preparedness capabilities to assist healthcare systems, healthcare coalitions, and healthcare organizations with developing preparedness and response strategies. Released in January 2012, the Healthcare Preparedness Capabilities: National Guidance for Healthcare System Preparedness assists state, local, healthcare coalition, and ESF #8 partners in identifying gaps in preparedness, determining specific priorities, and developing plans for building and sustaining healthcare-specific capabilities.

Aligning Capabilities with National Strategies The preparedness capabilities are based on evidence-informed documents, applicable preparedness literature, and subject matter expertise gathered from across the federal government and the state and local practice community. The capabilities align with public health and healthcare preparedness priorities in key legislative and executive directives, including:

· Sections 319C-1 and 319C-2 of the PHS Act, as amended by PAHPA, which authorizes the PHEP and HPP cooperative agreement programs;

· Homeland Security Presidential Directives (HSPD) 5 and 21;

· Presidential Policy Directive 8: National Preparedness. PPD 8 focuses on key capabilities and “whole-of-community” approaches that break down preparedness barriers. PPD 8 replaces HSPD 8 (2003) and HSPD-8 Annex I (2007) and aims to strengthen the security and resilience of the United States through systematic preparation for threats to the nation’s security, including acts of terrorism, pandemics, significant accidents, and catastrophic natural disasters; and

· National Health Security Strategy (NHSS) and its core capabilities: community resilience and recovery; infrastructure; situational awareness; incident management; disease control and mitigation; healthcare services; population safety and health; and quality improvement and accountability.

HPP-PHEP Cooperative Agreement Purpose

The purpose of the 2012-2017 HPP-PHEP cooperative agreement programs is to provide technical assistance and resources that support state, local, territorial, and tribal public health departments and healthcare systems/organizations in demonstrating measurable and sustainable progress toward achieving public health and healthcare preparedness capabilities that promote prepared and resilient communities.

Program Implementation HPP and PHEP program implementation activities should be focused on development of all healthcare and public health capabilities. Awardees are expected to use their cooperative agreement funding to build and sustain the public health and healthcare preparedness capabilities, ensuring that federal preparedness funds are directed to priority areas within their jurisdictions as identified through their strategic planning efforts. Awardees must demonstrate measurable and sustainable progress toward achieving all the preparedness capabilities over the five-year project period. In addition, awardees should be able to describe how effective implementation activities and programs have met the needs of at-risk individuals (also known as vulnerable or special needs) as required under PAHPA. The definition of at-risk individuals is available at: http://www.phe.gov/Preparedness/planning/abc/Documents/at-risk-individuals.pdf.

Cross-cutting HPP and PHEP activities should be managed, coordinated, and integrated where applicable. To further advance public health and healthcare preparedness, awardees should consider organizing their programs to align and integrate with jurisdictional preparedness planning priorities. Establishing such an organizational structure will help assure public health and healthcare preparedness program components are integrated and associated requirements are achieved, helping to assure more effective coordination, administration, and oversight of strategic and tactical program implementation activities.

Public health and healthcare systems have complementary yet unique characteristics, and both have specific preparedness and response roles. Grant alignment efforts are intended to maintain the uniqueness of each program, while ensuring both programs are jointly planning, exercising, and implementing program operations in a more coordinated fashion. Examples of potential joint activities or shared services include:

· Exercise planning and conduct

· Healthcare coalition planning

· Implementation of joint capability resource elements and tasks

· Information technology services

· Health Alert Networks (HAN)

· Communication platforms

In addition, HPP-PHEP grant alignment is designed to promote efficiencies through appropriate pooling of resources and leveraging of funds for applicable services, activities, and infrastructure while maintaining separate appropriation identities. However, leveraged funding must be used to support joint HPP-PHEP requirements. For instance, an integrated HPP-PHEP program at the awardee level could have one administrative structure that supports both programs. Examples of could include but are not limited to:

· Preparedness director

· Planners

· Exercise development staff

· Contract support staff

· Administrative assistants

· Legal support staff

· Grants management staff

· Evaluation staff

· Public information officers

Recipient Activities Public Health and Healthcare Preparedness Capabilities

ASPR and CDC have identified the following 15 public health and 8 healthcare capabilities as the basis for state and local public health and healthcare preparedness.

Each of the public health and healthcare preparedness capabilities includes a definition of the capability and a list of the associated functions, tasks, and resource element considerations. Public health departments should have or have access to the priority resource elements included in the public health preparedness capabilities to fully achieve those capabilities. In addition, HPP awardees are required to assess and address all planning resource elements in the healthcare preparedness capabilities to fully achieve those capabilities. (See Appendices 4 and 5 for more information on the capabilities and resource elements.)

ASPR and CDC have developed capabilities planning models that describe high-level planning processes awardees can use to help determine their preparedness priorities, plan appropriate preparedness activities, and demonstrate and evaluate achievement of capabilities. These processes also will assist awardees in developing required capabilities plans that must be submitted as part of their funding applications. (See Section IV.) The ASPR planning model is available at http://www.phe.gov/Preparedness/planning/hpp/Pages/default.aspx. The CDC planning model is available at http://www.cdc.gov/phpr/capabilities/DSLR_capabilities_July.pdf.

Prioritization of Healthcare Preparedness Capabilities

All capability planning resource elements must be addressed through a narrative outlining the status of completion as part of the capabilities work plan. Budget allocations will be focused at the function and resource element levels only. Full details on the required functions and resource elements that must be addressed in the capabilities work plan are available in Appendix 4. After work plans are completed, awardees should then prioritize within the eight healthcare preparedness capabilities those functions and resource elements for additional budget allocation based on their unique healthcare delivery preparedness needs as determined through the planning process, as well as all HPP requirements found in this funding opportunity announcement. This prioritization process is covered in Capability 1: Healthcare System Preparedness and includes:

1. The jurisdictional risk assessment/hazard vulnerability process

2. Resources assessment and gap analysis based on the status of the current capabilities

3. Development of priorities based on risk and need

Prioritization of Public Health Preparedness Capabilities

CDC strongly recommends that PHEP awardees prioritize their work and resulting investments regarding the 15 public health preparedness capabilities across the five-year project period based upon: 1) their jurisdictional risk assessments (see the Community Preparedness capability for additional or supporting detail on the requirements for this risk assessment), 2) an assessment of current capabilities and gaps using CDC’s Public Health Preparedness Capabilities: National Standards for State and Local Planning and the awardee capability self-assessment process, and 3) CDC’s recommended tiered strategy for capabilities:

Tier 1 Public Health Preparedness Capabilities:

· Public Health Laboratory Testing

· Public Health Surveillance and Epidemiological Investigation

· Community Preparedness

· Medical Countermeasure Dispensing

· Medical Materiel Management and Distribution

· Responder Safety and Health

· Emergency Operations Coordination

· Emergency Public Information and Warning

· Information Sharing

Tier 2 Public Health Preparedness Capabilities:

· Non-Pharmaceutical Intervention

· Medical Surge*

· Volunteer Management*

· Community Recovery

· Fatality Management*

· Mass Care

*PHEP funding should support the development of these Tier 2 capabilities in coordination with HPP activities.

CDC’s tiered strategy is designed to emphasize the Tier 1 capabilities as they provide the foundation for public health preparedness. PHEP awardees are strongly encouraged to build the priority resource elements in the Tier 1 capabilities prior to making significant or comprehensive investments in Tier 2 public health preparedness capabilities.

To date, ASPR does not tier its healthcare preparedness capabilities and expects HPP awardees to prioritize funding based on their planning model consistent with the planning process of the U.S. Department of Homeland Security preparedness cycle, which is outlined in Chapter 4 of FEMA’s Developing and Maintaining Emergency Operations Plans, Comprehensive Preparedness Guide (CPG) 101, Version 2.0. (See Appendix 4.) Through continued refinement resulting from information obtained from the awardee capability self-assessment process and further stakeholder engagement, ASPR may elect to provide HPP awardees with a tiered approach in subsequent budget periods.

Everyday Use. Each of the public health and healthcare preparedness capabilities identifies priority resource elements that are relevant to routine public health and healthcare activities and essential public health and healthcare services, as well as preparedness and response. Awardees can demonstrate achievement of capabilities through different means (e.g., exercises, planned events, and real incidents). In addition to exercises, awardees are encouraged to use routine activities and real incidents to evaluate their public health and healthcare preparedness capabilities when feasible.

Jurisdictional Risk Assessments

A central component of implementing a capability-based approach to preparedness and response efforts includes jurisdictional risk assessments (JRA) that identify potential hazards, vulnerabilities, and risks within the community that relate to the public health, medical, and mental/behavioral systems inclusive of at-risk individuals. (See Healthcare Preparedness Capability 1: Healthcare System Preparedness in Appendix 4 and Public Health Preparedness Capability 1: Community Preparedness in Appendix 5.) Jurisdictional risk assessment planning should use an all-hazards approach and include input from existing hazard and vulnerability assessments conducted by emergency management, healthcare organizations, and community partners. Awardees should use the results of their most current state, regional, and/or community-based JRA to help determine their gaps within each of the capabilities.

Program Strategies and Requirements

For Budget Period 1 of the new HPP-PHEP cooperative agreement project period, awardees must address and comply with joint program requirements, as well as specific HPP and PHEP requirements.

Joint HPP-PHEP Requirements

1. Foster greater HPP and PHEP program alignment. Awardees must demonstrate progress in coordinating public health and healthcare preparedness program activities and leveraging funding to support those activities and also track accomplishments highlighting the impact of the HPP and PHEP programs in awardee jurisdictions.

2. Conduct jurisdictional risk assessments. Awardees are required to conduct jurisdictional risk assessments (JRA) to identify potential hazards, vulnerabilities, and risks within the community that relate to the public health, medical, and mental/behavioral systems and the functional needs of at-risk individuals. Jurisdictional risk assessment planning should be a collaborative and flexible process that includes input from existing hazard and vulnerability assessments conducted by emergency management and healthcare organizations as well as community and regional partners. Awardees should use the results of their most current state, regional, and/or community-based JRA to help determine their gaps within each of the public health and healthcare capabilities.

HPP and PHEP awardees should develop public health, medical, and mental/behavioral health-focused JRAs in coordination with emergency management and community partners that, where applicable, utilize findings from their state or regional threat hazard identification risk assessment (THIRA). More information is available at http://www.dhs.gov/xlibrary/assets/rma-strategic-national-risk-assessment-ppd8.pdf.

3. Develop and implement administrative preparedness strategies. For the purposes of this FOA, administrative preparedness is defined as the process of ensuring that fiscal and administrative authorities and practices that govern funding, procurement, contracting, hiring, and legal capabilities necessary to mitigate, respond to, and recover from public health emergencies can be accelerated, modified, streamlined, and accountably managed at all levels of government. HPP and PHEP awardees should establish plans to effectively receive, obligate, and account for HPP and PHEP funds that are consistent with the purpose of the HPP and PHEP cooperative agreements. Plans must include the ability to move funding to the local level in a timely and effective manner.

It is critical that as awardees apply resources to achieve the public health and healthcare preparedness capabilities, they also plan how they will address the additional fiscal and administrative challenges they may face during a public health emergency. To ensure that these potential challenges are addressed, response plans should include emergency authorities and expedited administrative processes that would likely differ from the awardees’ standard procedures. As applicable, formal incident action plans (IAPs), after-action reports (AARs), improvement plans (IPs), awardee capability self-assessment data, and jurisdictional risk assessments may be considered in providing the actions taken or planned to overcome challenges and barriers within the scope of administrative preparedness.

In addition to the application project narrative, which describes the standard administrative operating procedures, awardees should develop and submit plans to ASPR and CDC no later than September 30, 2012, that address the following three areas:

· Alignment of the HPP-PHEP administrative processes: Describe how funds will be managed between the two programs, including processes for:

· Streamlining and consolidating contracting procedures;

· Tracking HPP and PHEP funds separately;

· Tracking match and maintenance of funding/maintaining state funding requirements separately;

· Meeting fiscal reporting requirements, including timely submission of separate SF 425 Federal Financial Reports (FFRs);

· Conducting required A-133 audits and other program audits as required; and

· Designating authorized official(s) to access the payment management accounts to draw down HPP and PHEP funds.

· Describe and provide citations for the following awardee emergency legal authorities:

· Expedited procedures for receiving, allocating, and spending emergency funds, including the ability to quickly move emergency funds from the state level to local governments;

· Waivers or similar legal processes that can be used to minimize the potential conflicts between emergency use authorizations (EUA) and state-based pharmaceutical, prescribing, labeling, and other drug-related laws. If no waivers or similar legal processes exist, please describe laws that may potentially conflict with EUAs;

· Formal memoranda of understanding or agreement (MOU/MOA) for joint investigations of intentional public health threats or incidents, signed and executed between the appropriate Federal Bureau of Investigation field office and state public health departments, and including local public health departments where relevant (such as in home rule states); and

· Protection of volunteers against tort liability and workers’ compensation claims (excluding federal mechanisms, e.g., the Public Readiness and Emergency Preparedness Act). Please distinguish between in-state and out-of-state volunteers and indicate whether your state can use the Emergency Management Assistance Compact to send or receive volunteers.

· Describe expedited fiscal and other administrative processes, such as:

· Emergency procurement and contracting authorities and processes and how they differ from day-to-day business processes;

· Emergency hiring processes (workforce surge) and how they differ from customary hiring processes;

· Reporting/monitoring methodology to ensure payment efficiency and funding accountability; and

· Emergency procedures for allocating funds to local and tribal health departments and other subawardees.

4. Coordinate exercise planning and implementation. Awardees must develop multiyear exercise plans for conducting exercises to test public health and healthcare preparedness capabilities. In addition, awardees must conduct one joint, full-scale exercise within the five-year project period. Joint exercises should meet multiple program requirements, including HPP, PHEP, and Strategic National Stockpile/Cities Readiness Initiative/CHEMPACK requirements (see Appendix 10) to help minimize the burden on exercise planners and participants. Exercise plans must demonstrate coordination with relevant entities and include methods to leverage resources to the maximum extent possible. Exercise plans must be submitted annually on or before the funding application deadline to the CDC/DSLR secure channel on www.llis.gov. Plans must include proposed exercise schedules and describe exercise goals and objectives, identified capabilities to be tested, inclusion of at-risk individuals, participating partner organizations, and previously identified improvement plan items from real incidents or previous exercises. This multiyear exercise plan must be updated annually and should comply with additional HPP- and PHEP-specific exercise requirements outlined in the HPP and PHEP program requirement sections.

5. Healthcare coalition planning. Awardees must contribute to successful coordinated preparedness. To do so, a plan must be developed to coordinate preparedness efforts among healthcare, public health, and behavioral health at the healthcare coalition level. This plan must include the strategy which HPP and PHEP awardees will use to encourage coordinated preparedness between healthcare and public health as well as how they will interact and plan with the primary preparedness agency and their partners at the jurisdictional level. Plans must be submitted by September 30, 2012.

6. Integrate preparedness efforts across jurisdictions. Awardees must establish and maintain advisory committees comprised of senior officials from governmental and nongovernmental organizations involved in homeland security, healthcare, public health, and behavioral health to integrate preparedness efforts across jurisdictions and to leverage funding streams. This will enable HPP and PHEP program components as a whole to complement and better coordinate with other public health and preparedness programs as applicable.

The membership of the senior advisory committee must, at a minimum, and to the extent allowed by applicable law, include jurisdictional officials directly responsible for the administration of Department of Homeland Security preparedness grants and ASPR and CDC preparedness cooperative agreements, such as the:

· State administrative agency (SAA),

· Jurisdictional HPP director, principal investigator, or coordinator,

· Jurisdictional PHEP director or principal investigator,

· Jurisdictional emergency management agency representative, Jurisdictional emergency medical services representative,

· Jurisdictional medical examiner, and

· Jurisdictional hospital representative.

Awardees are strongly encouraged to broaden advisory committee membership to include representatives from additional disciplines (e.g., legal counsel and finance), local jurisdictions and associations, and regional working groups. Advisory committees should also include citizen representation, including those representing at-risk individuals, to obtain public input and comment on emergency preparedness planning.

7. Obtain public comment and input on public health emergency preparedness and response plans and their implementation, using existing advisory committees or a similar mechanism to ensure ongoing public comment and to obtain comment from other state, local, and tribal stakeholders. (See Appendix 4: Healthcare System Preparedness capability, Function 2: Coordinate healthcare planning to prepare the healthcare system for a disaster; See Appendix 5: Community Preparedness capability, Function 2: Build community partnerships to support health preparedness.)

8. Meet Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP) compliance requirements. (See Appendix 4: Volunteer Management capability, Function 1: Participate with volunteer planning processes to determine the need for volunteers in healthcare organizations; Appendix 5: Volunteer Management capability, Function 1: Coordinate volunteers; and Appendix 12: ESAR-VHP Compliance Requirements.)

9. Engage in technical assistance planning. Awardees must actively work with ASPR and CDC project officers to develop individualized technical assistance plans within 90 days of the start of the budget period. The consolidated HPP-PHEP technical assistance plans will include awardee-identified and project officer-identified technical assistance needs and a joint strategy for addressing those needs. Technical assistance plans will be monitored on a regular basis and updated by project officers and awardees as part of the mid-year review process.

10. Plan and conduct joint site visits. Awardees should be actively involved in the planning and execution of routine site visits conducted by ASPR and CDC project officers to assess the activities, progress, and challenges of awardees and their subcontractors. Awardees shall maintain all program documentation that substantiates achievement of capabilities, performance measures, and other programmatic requirements, including all-hazards public health emergency preparedness and response plans, and make those documents available to ASPR and CDC staff, as requested, during site visits or through other requests. Awardees should plan on hosting site visits at least once every 12 to 18 months.

11. Submit pandemic influenza plans annually as required by Section 319C-1 and 319C-2 of the PHS Act and amended by PAHPA. ASPR and CDC will provide further information on the 2012 submission in a separate guidance document.

HPP Requirements

HPP cooperative agreement funds will be used to continue maintaining and refining medical surge capacity and capability at the state and local levels through associated planning, personnel, equipment, training, exercises, and healthcare coalition development. ASPR recognizes that maintenance and refinement of current capabilities and functions are critical for the sustainability of awardee preparedness efforts.

Awardees must complete and submit all required HPP funding application components, including project abstracts, project narratives, work plans, and budgets as outlined in Section IV, with an emphasis on short-term and long-term plans to address the Healthcare Preparedness Capabilities: National Guidance for Healthcare System Preparedness; and complete and report on activities described in the application work plans.

Awardees must describe in either their funding application project narratives or capability plans the activities they plan to conduct to comply with the following requirements. Where applicable, the appropriate capability sections are listed with each requirement.

1. Address required resource elements. Awardees are expected to address all planning resource elements listed as required in each capability of the healthcare preparedness capabilities appendix. Resource elements indicated as “based on priorities and needs” should be assessed by the awardee or designee with determination for completion based on the priorities and needs of the targeted stakeholder. (See Appendix 4 for additional information on the Healthcare Preparedness Capabilities: National Guidance for Healthcare System Preparedness. The complete document is available at http://www.phe.gov/Preparedness/planning/hpp/reports/Documents/capabilities.pdf.)

In addition to these requirements, and before funding additional activities based on the prioritization process, specific capability components must be fully addressed as described below.

2. Develop healthcare coalitions. Awardees are expected to develop or refine healthcare coalitions as outlined in Capability 1: Healthcare System Preparedness; Function 1: Develop, refine, and sustain healthcare coalitions; and in Capability 10: Medical Surge; Function 1: The healthcare coalition assists with the coordination of the healthcare organization response during incidents that require medical surge. (See Appendix 4.)

Staged development of healthcare coalitions is acceptable during the five-year project period. This staged approach is based on initial assessment of the capabilities and functions to include the associated resource elements of Capability 1, Function 1. The following stages of healthcare coalition development will be used during this process with the first stage based on the assumption that the awardee has not met any of the requirements outlined in these healthcare coalition functions. Timelines for staged development will be determined as a collaborative process between awardees and their project officers.

Stage 1:

· Determine regional approach and boundaries

· Establish awardee support and partnership

· Determine governance structure

· Establish the healthcare coalition for purposes of preparedness through appropriate documentation Stage 2:

· Maintain the above healthcare coalition Stage 1 requirements through sustainment and preparedness activities

· Perform preparedness activities as outlined in Capability 1: Healthcare System Preparedness

Stage 3:

· Determine how healthcare coalitions will address multiagency coordination during response and perform ongoing regional exercises to test this capability. Healthcare coalition multiagency coordination is outlined in Capability 3: Emergency Operations Coordination and Capability 10: Medical Surge.

The following must be addressed in Budget Period 1 funding applications and annual progress reports:

1. Awardees must provide in their funding application project narratives plans to assess the healthcare coalitions in their jurisdictions and to determine which stage of development their coalitions are in during Budget Period 1.

2. Awardees that consider their healthcare coalitions to be in Stage 2 must submit plans that outline strategies to meet Stage 3 requirements and be prepared to provide documentation of Stage 1 completion.

3. Awardees that consider their healthcare coalitions to be in Stage 3 must submit plans that outline strategies to continue sustainment and exercise planning to strengthen their coalitions and be prepared to provide documentation of Stage 1 and Stage 2 completion.

3. Identify existing healthcare coalitions. HPP awardees funded under this announcement must provide to ASPR basic information describing the extent of healthcare preparedness coalitions (hereafter referred to as coalitions) that currently exist within their states. Each awardee that anticipates receiving HPP funds for fiscal year 2012 is required to provide the following information as two separate attachments to their Budget Period 1 funding applications:

· Attachment 1: The number of participating healthcare coalitions within the awardee’s state working toward Capability 1: Healthcare System Preparedness. For each coalition, identify the:

· Coalition name;

· Coalition members by type (i.e., hospital, long-term care center, community health center), name, and national provider identification (NPI) number;

· Coalition stage of development;

· Coalition point of contact (POC) name;

· POC telephone number;

· POC street address;

· POC e-mail address; and

· Coalition Web site address (if one exists)

· Attachment 2: A map by zip code or county of the health service regional areas within the state that are covered by each coalition.

In partnership with each HPP awardee, all identified coalitions will complete a questionnaire to describe their characteristics and functions. ASPR will use this data to establish baseline information on existing coalitions. Results will be shared with the awardees.

4. Develop and implement healthcare system exercise and evaluation programs.

Exercise Program: Budget Period 1 HPP funding applications must address the evaluation of state and local preparedness and response capabilities through exercises.

Exercise Plans: Awardees must develop, refine, and submit a multiyear exercise plan for conducting substate regional or statewide, functional or full-scale exercises to test the ASPR healthcare preparedness capabilities. Local public health should be included in exercises that have healthcare participation based on the submitted exercise plans.

Within the exercise plan, awardees must:

· Delineate exercise location, dates, and how healthcare systems are involved;

· Describe the healthcare system role in multiple capabilities;

· Describe the lessons learned and next steps;

· Describe integration of training initiatives into exercises.

HPP awardees must ensure that all HPP participating hospitals participate in at least one substate regional or statewide Homeland Security Exercise and Evaluation Program (HSEEP)-based functional or full-scale exercise during the five-year project period.

Please see Appendix 11 for details on exercise-related evaluation and annual progress report requirements.

5. Support training and education.

Awardees will assess and report annually which participating healthcare organizations currently have adopted all NIMS implementation activities and which are still in the process of implementing the 11 activities. For any participating healthcare organization still working to implement NIMS activities, funds must be prioritized and made available during HPP Budget Period 1 to ensure the full implementation and maintenance of all activities during the five-year project period.

Healthcare Organizations: All participating healthcare organizations must comprehensively track all NIMS implementation activities and report on those activities annually as part of the reporting requirements for this cooperative agreement.

The following information must be addressed and submitted as an attachment with the HPP Budget Period 1 funding applications (a data extraction of which is to be entered into the PERFORMS application module on NIMS requirements); an update of the inventory must be included in annual progress reports:

· A comprehensive inventory that lists participating healthcare organizations; identifies each of the 11 NIMS implementation activities that have been achieved; and identifies each activity still in progress;

· The comprehensive inventory must include each participating healthcare organization’s respective national provider identification (NPI) number; and

· Detailed descriptions of all implementation activities with associated budget allocations, that ensure all healthcare organizations achieve and maintain all activities during Budget Period 1.

Gap-based Training

Awardees should ensure that education and training opportunities/programs exist for healthcare workers based on training needs to address gaps in capabilities and that are prioritized by awardees or their designees.

Awardees must undertake activities that ensure all education and training opportunities/programs enhance the ability of healthcare workers to respond in a coordinated manner that does not overlap with those from local health departments, community healthcare organizations, emergency response agencies, public safety agencies, and others. To reduce costs and build relationships, joint training of all healthcare organization workers is strongly encouraged.

For HPP awardees, funds may be used to support the cost of healthcare organization worker participation in training centered on capability development; to prepare workers with the necessary knowledge, skills, and abilities to perform/enhance the capability; and to participate in exercises on those capabilities or related systems.

Additionally, HPP awardees are expected to work closely with their subawardees in determining cost-sharing arrangements that will facilitate the maximum number of workers participating in training, and exercise activities.

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